Neonatal & Pediatric Emergencies MCQ Quiz | Pediatric Surgery

Quiz Introduction

Welcome to the Neonatal & Pediatric Emergencies Quiz, an essential resource for MBBS students specializing in Pediatric Surgery. This quiz is designed to test and reinforce your knowledge of critical conditions requiring immediate surgical intervention in newborns and children. Covering a spectrum of emergencies from congenital diaphragmatic hernia and malrotation with volvulus to intussusception and necrotizing enterocolitis, these 25 multiple-choice questions will challenge your diagnostic and management skills. Each question is crafted to reflect clinical scenarios you may encounter. After completing the quiz, you can review your performance with detailed answer feedback. For your convenience, a complete list of all questions and their correct answers is available for download as a PDF.

1. A 3-week-old male infant presents with non-bilious projectile vomiting after feeds for the past 3 days. On examination, a small, firm, olive-shaped mass is palpable in the epigastrium. What is the most likely diagnosis?

Duodenal atresia

Hypertrophic pyloric stenosis

Malrotation with volvulus

Gastroesophageal reflux

2. The classic radiological finding for necrotizing enterocolitis (NEC) on an abdominal X-ray is:

Double bubble sign

Pneumatosis intestinalis

Target sign

Corkscrew sign

3. A newborn presents with bilious vomiting within the first 24 hours of life. An upper GI series reveals a “corkscrew” appearance of the duodenum. What is the definitive management?

Hydrostatic reduction

Pyloromyotomy

Emergency laparotomy (Ladd’s procedure)

Serial rectal irrigations

4. An 8-month-old infant presents with episodes of inconsolable crying, drawing up his legs, and has passed a “currant jelly” stool. The investigation of choice for both diagnosis and initial therapy is:

Abdominal CT scan

Upper GI series

Diagnostic laparoscopy

Therapeutic air or contrast enema

5. A newborn is born with a scaphoid abdomen, respiratory distress, and bowel sounds heard over the left chest. What is the most critical initial step in management?

Immediate bag-mask ventilation

Insert a chest tube on the affected side

Immediate intubation and gastric decompression

Emergency surgical repair

6. Which of the following statements correctly differentiates gastroschisis from omphalocele?

Gastroschisis has a covering sac, while omphalocele does not.

Omphalocele is associated with a higher rate of other congenital anomalies.

Gastroschisis involves a defect at the umbilicus, while omphalocele is to the right.

Bowel injury is more common with omphalocele due to exposure.

7. A newborn fails to pass meconium in the first 48 hours of life and develops abdominal distension. A rectal biopsy is performed to confirm the diagnosis of Hirschsprung’s disease. The biopsy must show:

Hypertrophied nerve trunks and absence of ganglion cells.

Presence of meconium plugs in the crypts.

Abundance of both Meissner’s and Auerbach’s plexuses.

Inflammatory infiltrate in the submucosa.

8. A 14-year-old boy presents to the ER with sudden onset of severe left scrotal pain, nausea, and vomiting. On examination, the left testis is high-riding and exquisitely tender, and the cremasteric reflex is absent. What is the most appropriate next step?

Administer antibiotics for epididymitis.

Perform a Doppler ultrasound to confirm blood flow.

Attempt manual detorsion in the ER.

Immediate surgical exploration of the scrotum.

9. The “double bubble” sign on a neonatal abdominal X-ray is pathognomonic for:

Pyloric stenosis

Jejunal atresia

Duodenal atresia

Ileal atresia

10. Meconium ileus, a common cause of neonatal intestinal obstruction, is strongly associated with which genetic condition?

Trisomy 21 (Down Syndrome)

Cystic Fibrosis

Trisomy 18 (Edwards Syndrome)

Turner Syndrome

11. A newborn presents with excessive drooling, choking, and cyanosis with the first feed. An attempt to pass a nasogastric tube meets resistance. What is the most likely diagnosis?

Laryngomalacia

Congenital diaphragmatic hernia

Esophageal atresia with tracheoesophageal fistula

Pyloric atresia

12. The VACTERL association includes vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities. This is frequently seen in patients with:

Gastroschisis

Imperforate anus

Pyloric stenosis

Intussusception

13. A 2-month-old infant presents with a groin swelling that is firm, tender, and cannot be reduced. The infant has also started vomiting. This clinical picture is most consistent with:

A reducible inguinal hernia

Hydrocele

An incarcerated inguinal hernia

Lymphadenopathy

14. The most common cause of bladder outlet obstruction in male infants is:

Urethral stricture

Meatal stenosis

Posterior urethral valves (PUV)

Detrusor-sphincter dyssynergia

15. A 2-week-old infant is brought in with persistent jaundice, pale (acholic) stools, and dark urine. The direct bilirubin is elevated. This is highly suggestive of:

Breast milk jaundice

Physiological jaundice

Biliary atresia

Crigler-Najjar syndrome

16. The initial management of a stable preterm infant diagnosed with necrotizing enterocolitis (NEC) Stage I or II primarily involves:

Emergency exploratory laparotomy

Medical management with bowel rest (NPO) and broad-spectrum antibiotics

Peritoneal drainage at the bedside

Administration of probiotics and immediate enteral feeding

17. A 2-year-old child aspirates a peanut. The classic triad of symptoms for foreign body aspiration includes:

Fever, cough, and stridor

Cough, wheezing, and decreased breath sounds

Drooling, dysphagia, and respiratory distress

Vomiting, abdominal pain, and cyanosis

18. What is the most common organ injured in children following blunt abdominal trauma?

Liver

Kidney

Spleen

Pancreas

19. The Kasai procedure (hepatoportoenterostomy) is the surgical treatment for which neonatal emergency?

Choledochal cyst

Biliary atresia

Annular pancreas

Alagille syndrome

20. In a child with suspected appendicitis, which finding is most suggestive of perforation?

Pain migrating from periumbilical to the right lower quadrant

Anorexia and nausea

Sudden relief of pain followed by signs of generalized peritonitis

A positive Rovsing’s sign

21. A newborn is diagnosed with a large sacrococcygeal teratoma. The most immediate life-threatening risk associated with this condition is:

Malignant transformation

High-output cardiac failure due to arteriovenous shunting

Bowel obstruction

Neurological deficits

22. Which imaging modality is considered the gold standard for diagnosing intussusception in children?

Plain abdominal X-ray

CT scan of the abdomen

Barium enema

Ultrasound of the abdomen

23. The classic metabolic abnormality associated with hypertrophic pyloric stenosis is:

Hyperchloremic metabolic acidosis

Hypochloremic metabolic alkalosis with hypokalemia

Respiratory acidosis

Normal anion gap metabolic acidosis

24. What is the most common type of tracheoesophageal fistula (TEF)?

Esophageal atresia with a distal TEF (Type C)

Isolated esophageal atresia without fistula (Type A)

H-type fistula without atresia (Type E)

Esophageal atresia with a proximal TEF (Type B)

25. An absolute contraindication for non-operative reduction (air/contrast enema) of intussusception is:

Age less than 3 months

Symptoms present for more than 24 hours

Presence of a lead point on ultrasound

Signs of peritonitis or perforation

Neonatal & Pediatric Emergencies MCQ Quiz | Pediatric Surgery

Quiz Introduction

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